Pregnant Women With Chronic Glomerulonephritis
What is Pregnant Women With Chronic Glomerulonephritis
Chronic glomerulonephritis, referred to as chronic nephritis Department of pregnant women with chronic glomerulonephritis caused by a variety of primary glomerular disease, proteinuria, hematuria, edema, hypertension clinical features of chronic diseases. With the progression of the disease, late anemia and renal dysfunction. Since carry out kidney biopsy, found that pregnant women with high blood pressure patients, about 20% of the lesions of chronic nephritis. The pregnancy of chronic glomerulonephritis endurance depends on the degree of blood pressure control and renal dysfunction.
Symptoms of Pregnant Women With Chronic Glomerulonephritis
Pregnancy edema, hypertension, hematuria, proteinuria in pregnant women.
(A) The main symptoms
1. Edema edema FEATURES for early morning eyelid and facial edema gradually developed to generalized edema was pitting. Patients with chronic glomerulonephritis lost a lot of protein in the urine of pregnant women with chronic glomerulonephritis the symptoms accompanied anorexia from inadequate protein intake can cause hypoproteinemia caused by reduced plasma osmolality, water from blood vessels into the tissue spaces, manifested as edema. In addition, due to the body's lack of effective circulating blood volume, the renin - angiotensin - aldosterone system activation can lead to increased tubular sodium reabsorption, further cause sodium and water retention, increased edema.
2 The the proteinuria majority of patients with proteinuria. Chronic glomerulonephritis patients with kidney filtration membrane barrier function of the normal charge barrier and molecular barriers, glomerular plasma protein permeability-increasing protein content than when the original urine proximal tubular reabsorption capacity , the huge loss of protein from the urine form proteinuria.
3. Hematuria may have microscopic hematuria and gross hematuria. The former normal urine, latter urine Secheng the washing meat water, tea or red. Glomerulonephritis patients with autoimmune abnormalities caused by the destruction of the glomerular basement membrane function, red blood cells into the urine formation hematuria. The immune response may also renal vascular inflammatory reaction, necrosis, dilatation, stenosis, occlusion caused hematuria.
4 hypertension in the majority of patients with varying severity of high blood pressure, some during pregnancy for the outstanding performance in patients with chronic glomerulonephritis with hypertension, or hypertensive encephalopathy and hypertensive heart disease, patients with multiple retinal hemorrhage exudation. Chronic glomerulonephritis, renal ischemia activate RAS, causes vasoconstriction and increased peripheral resistance, elevated blood pressure; reduce kinin generated by the kidney, PGE2, PGA2 buck substances can also cause blood pressure at the same time because of the destruction of the nephron increased.
(B) Secondary symptoms
Renal parenchymal damage. Anemia because the kidneys produce erythropoietin reduced, causing anemia. Anemia type mostly positive pigmented cells anemia. Patients showed pale skin, mucous membranes, such as the conjunctiva, nail beds, lips parts, pregnant women with chronic glomerulonephritis symptoms may have lack of appetite, nausea, vomiting, bloating, dizziness, fatigue, heart rate and breathing faster.
. Nocturia due to glomerulonephritis patients nephron damage, renal blood flow, renal units focused on healthy after its original urine generated increased; and tubular flow rate increases relatively, relatively reduced reabsorption, resulting in urine The amount of the increase; healthy after increased solute nephron glomerular filtration, can cause osmotic diuresis also increased urine. Nocturnal urine output close to or more than the urine during the day. The increased frequency of urination at night, more than two times.
3 other long-term low-grade fever, fatigue, lower back soreness and discomfort.
Pregnant women with chronic glomerulonephritis patients manifested as pale skin, mucous membranes, such as the conjunctiva, nail beds, lips parts, eyelid and facial edema can be faster heart rate and breathing.
What Causes Pregnant Women With Chronic Glomerulonephritis
Chronic glomerulonephritis and other chronic kidney disease, pregnancy pregnancy endurance depends on the degree of blood pressure control and renal dysfunction. The cause of pregnant women with chronic glomerulonephritis with normal renal function or mild insufficiency usually weather during pregnancy, half of women with severe renal insufficiency complicated by hypertension, proteinuria, premature birth, fetal growth restriction. Easily complicated by hypertensive disorders in pregnancy, and further increased kidney damage, severe, 25% of renal function deteriorated sharply, resulting in the postpartum several months to 1 to 2 years to develop into end-stage renal failure.
Tests and Diagnosis for Pregnant Women With Chronic Glomerulonephritis
(A) Primary Inspection
1. Performance of urine for proteinuria and (or) hematuria, 24-hour urine total protein often in of 1 ~~ 3g urinary sediment to see granular casts and waxy casts. Normal urine microscopic hematuria, gross hematuria, urine Secheng wash the meat water, tea or red. The urine density decreased (1.007 to 1.013). Pregnant women with chronic glomerulonephritis check red blood cells and white blood tube.
Blood tests early blood count may be normal or mild anemia, red blood cells, hemoglobin value decreased, white blood cells and platelets in the normal range. Reduce plasma proteins appear hypoproteinemia white / ball than the inverted seriously ill by an increase in non-protein nitrogen, often in more than 15.9mmol / L.
Renal function in the majority of patients with long-term renal stabilization period, late may have urinary dysfunction concentration, elevated serum creatinine and endogenous creatinine clearance rate. If pregnancy serum creatinine> 61 88 μmol / L, urea nitrogen> 4 64mmol / L, said kidney function damage.
(B) secondary check
Fundus examination the early chronic nephritis fundus examination may be normal. Late may have arteriosclerosis flexion movement pulse pressure trace retinal cotton wool oozing or bleeding. Hypertension, chronic glomerulonephritis fundus examination bleeding, oozing performance.
Kidney biopsy showed diffuse or focal mesangial cells, capillary endothelial cells, podocyte hyperplasia matrix increased. Pregnant women with the diagnosis of chronic glomerulonephritis under the small of the same type are sometimes accompanied by of glomerular segmental glomerulosclerosis and balloon adhesions. Can be the clear chronic nephritis pathological type helps to understand the extent of disease, and can be used to guide therapy and prognosis.
(3) Check the Note
1 in patients with advanced chronic nephritis urine, urinary protein excretion can be reduced, because the late injured renal units increased glomerular injury is serious, however, reduced protein leakage. The severity of their condition can refer to how much urine red blood cells and white blood tube.
Kidney biopsy advanced chronic glomerulonephritis may have abnormal coagulation, renal biopsy may lead to bleeding.
Hypertensive disorders in pregnancy after 20 weeks of pregnancy, before pregnancy, a history of edema, proteinuria. More than first appeared after the onset of edema, proteinuria and hypertension appeared later. And more with hematuria and urinary sediment abnormalities. Postpartum 6 weeks to 3 months more than to return to normal.
2. Chronic renal pelvis nephritis patients with a history of urinary tract infection, and recurring bladder irritation, long-term low-grade fever, lower back pain and discomfort. The urine check leukocytes more pregnant women with chronic glomerulonephritis check white blood tube, urinary protein excretion generally 1 ~ 2g/24 h, the culture-positive urine bacterial and chronic glomerulonephritis erythrocyte more sometimes visible the red tube urine protein> 3g/24h.
3. Connective tissue disease, systemic lupus erythematosus, nodular artery go far more collagen diseases, high incidence of kidney damage, and its clinical features similar to chronic nephritis, but most of these diseases accompanied by systemic and other systems symptoms, such as fever, rash, joint pain, hepatosplenomegaly inspection found the characteristic indicators abnormalities (such as lupus nephritis, blood tests can be seen antinuclear antibody positive).
4. Chronic nephritis essential hypertension blood pressure continued to increase with essential hypertension associated with the identification of kidney damage, which the age of onset is usually after the age of 40, hypertension early proteinuria, tubular, and blood chemistry changes generally do not appear , hypertension Before the change appears in the urine, urinary protein often not serious and renal tubular dysfunction obvious. Heart, cerebrovascular and retinal vascular sclerosis changes often obvious.
Treatments of Pregnant Women With Chronic Glomerulonephritis
(A) The principle of treatment
Physician co-processing, control blood pressure, prevent infection, and the timely termination of pregnancy.
(B) the specific treatment
General treatment during pregnancy with sufficient rest and sleep to avoid fatigue, infection, the treatment of pregnant women with chronic glomerulonephritis; vitamin supplements: the protein content in the diet of low protein low phosphorus diet daily not more than 40g appropriate, choose Rich quality protein containing essential amino acids.
Control blood pressure can be applied to beta blockers, calcium channel blockers, alpha blockers and methyldopa be buck.
The principle of choice of antihypertensive drugs: non-toxic side effects on the fetus, and does not affect cardiac output, renal plasma flow and uteroplacental perfusion, and does not lead to a sharp drop in blood pressure or falling too low. Ideal standard for blood pressure to a systolic blood pressure of 140 ~ 155mmHg, diastolic blood pressure 90 to 105mmHg.
Labetalol: (1) Yiming Liu amine benzyl heart set for salicylic acid ammonia derivatives, α, β receptor competitive antagonism.
Drug advantages: (1) the antihypertensive effect, reduces vascular resistance, renal blood flow and placental blood flow without reducing; ② promote fetal lung maturation; ③ increase prostacyclin levels, reduce platelet consumption and anti-platelet aggregation ; ④ intravenous infusion, the blood pressure gradually decreased, but no palpitations, facial flushing and vomiting and other adverse reactions. So easy for patients to accept.
Usage: 100 mg twice daily, orally, the maximum amount of 240mg / day, or labetalol 20mg, treatment of pregnant women with chronic glomerulonephritis intravenous dose was doubled after 10 minutes, the maximum single dose of 80mg, until the blood pressure is controlled. Maximum daily dose of 220mg.
Note: ① preterm labor tendencies patients unfit for use; ② The asthma and cerebral hemorrhage in patients unfit for intravenous infusion; ③ myocardial infarction reduction should be slow; ④ adverse scalp tingling and vomiting.
(2) Nifedipine: also known as nifedipine, a calcium channel blockers. Prevent extracellular calcium ions penetrate the cell membrane into the cell, and inhibit the intracellular sarcoplasmic reticulum calcium release into the cytoplasm. Myofibrillar ATP enzyme present in the cytoplasm, preventing calcium ions into the cytoplasm, followed by blocking ATP enzyme activation and cleavage of ATP, the energy source interrupt the smooth muscle contraction required. The result of its pharmacological effects are systemic vasodilation, decreased blood pressure.
Usage: 10 mg three times a day, orally; or 6 hours, 24 hours total does not exceed 60mg. Adverse palpitations, headache, synergy with magnesium sulfate.
(3) nimodipine: is also a calcium channel blocker, and its advantages in that the cerebral vascular expansion optional. Usage: 20mg, 2 to 3 times a day, orally;, or 20 ~ 40mg adding 5% glucose solution 250ml intravenous infusion, day 1, the daily total does not exceed 360mg. Drug adverse reactions as headache, nausea, heart palpitations, and facial flushing.
(4) methyldopa: catecholamine metabolism can interfere with and excited hypothalamic vasomotor center α-receptor inhibition of peripheral sympathetic and lower blood pressure during pregnancy better. Treatment of pregnant women with chronic glomerulonephritis usage: 250mg, 3 times a day, orally. Adverse drowsiness, constipation, dry mouth, bradycardia.
(5) hydralazine: α-blockers, the expansion of peripheral blood vessels, reducing vascular tone and lower blood pressure and may increase cardiac output, improve perfusion of the brain, kidney, uterus and placenta. The antihypertensive effect, diastolic blood pressure decreased significantly.
Usage: administered every 15 to 20 minutes, 5 ~ 10mg, until the diastolic blood pressure control in 90 ~~ 100mmHg; 10 ~ 20 mg per H2_3 oral; 40mg adding 5% glucose solution 500ml infusion. Patients with heart failure should not apply this medicine.
Renal serum creatinine the <132.5μmol / L during pregnancy does not continue to rise, may continue the pregnancy. Once it is found that the deterioration of renal function, it shall terminate the pregnancy.
Vaginal delivery stable condition of pregnant women, fetal growth and in good condition, termination of pregnancy at 38 weeks' gestation. Vaginal delivery, pay attention to rest, try to shorten the second stage of labor, after giving antibiotics to prevent infection.
5. Cesarean the latter half of pregnancy should be hospitalized. After 33 weeks of pregnancy, the treatment of pregnant women with chronic glomerulonephritis subject placental dysfunction, termination of pregnancy should be timely cesarean section.
(3) in the treatment of Note
During pregnancy in hypercoagulable state limitations intravascular coagulation, prone to fibrin deposition and crescent formation, increased kidney ischemic lesions and renal failure, further deterioration.
Chronic nephritis pregnancy depends on the severity of the kidney disease. Mild, the prognosis is good; serious condition increased perinatal child mortality; early pregnancy or gestational hypertension and azotemia likely to develop pre-eclampsia or eclampsia, miscarriage, stillbirth and death increased incidence of production.
3. Deterioration of renal function, should be to find a reversible, such as urinary tract infections, dehydration or electrolyte imbalance. Nearly full-term, 15% to 20% decreased renal function (serum creatinine slightly elevated) is allowed. Reversible causes of renal function decline and can not find you should consider terminating the pregnancy. If there is only an increase in urinary protein, renal function is still good, no high blood pressure, gestational age less than 36 weeks, you should expect to observe, no termination of pregnancy indications.
Hypertension control is particularly important, but not salt restriction and diuretic. Antihypertensive drugs during pregnancy should not be the use of angiotensin-converting enzyme inhibitors can cause fetal malformation syndrome, neonatal renal failure, intrauterine growth restriction, and can significantly decrease placental blood flow. Recent studies have found that hydralazine pregnant women is more severe hypotension, higher cesarean section rate, a higher incidence of placental abruption, adverse effects on the fetal heart rate, Apgar low score more, it should not be drugs as first-line treatment of hypertensive disorders in pregnancy.
5. Following six unfit pregnancy.
(1) onset was the chronic nephritis performance of acute nephritic syndrome.
(2) acute nephritis cure or not to cure but stable condition after three years.
(3) The urine protein ≥ 3g / d or blood pressure ≥ 150/100mmHg. (4) non-pregnancy renal dysfunction the preconception serum creatinine> 265.2μmol / L or urea nitrogen> 10.71mmol / L. (5) pregnancy monitoring: pregnancy dynamic observation of blood pressure, urine protein, edema, anemia, renal function and fetal placental function. Such as pregnancy progressed smoothly, and the treatment of pregnant women with chronic glomerulonephritis should be admitted to hospital at 32 weeks of observation.
(6) control of blood pressure is the key to prevent the worsening of the disease, but the buck should not be too fast to prevent a sharp decrease in renal blood flow. The diuretic the process to prevent hypokalemia.